Plasticity of interneuronal networks of the functionally isolated human spinal cord

Brain Res Rev, 2008 · DOI: 10.1016/j.brainresrev.2007.07.012 · Published: January 1, 2008

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

The loss of walking after spinal cord injury is thought to be because the brain's control over the spinal cord is reduced. This article focuses on how sensory input interacts with the spinal cord to generate walking patterns. The study looks at individuals with complete spinal cord injuries where the brain has no detectable influence on the spinal networks. This allows researchers to study how sensory input interacts with the spinal cord's interneuronal networks. Even individuals with clinically complete spinal cord injury can generate locomotor patterns during stepping with assistance. However, they cannot sustain overground walking, which suggests the excitability of spinal circuits is compromised.

Study Duration

Not specified

Participants

Twenty-nine individuals with clinically complete spinal cord injury

Evidence Level

Not specified

Key Findings

1
The functionally isolated human spinal cord has the capacity to generate locomotor patterns with appropriate afferent input, demonstrating the importance of sensory feedback.
2
Individuals with clinically complete spinal cord injury show significant variability in motor patterns during stepping, indicating state-dependence of the human spinal networks.
3
Repetitive presentation of specific sensory information can functionally reorganize the spinal networks even in the absence of supraspinal input.

Research Summary

This article discusses the capacity of the functionally isolated human spinal cord to generate locomotor patterns with appropriate sensory input, despite the loss of supraspinal control after spinal cord injury. The research highlights the variability in motor patterns among individuals with complete spinal cord injury and emphasizes the role of sensory feedback in driving locomotor-like output. The study suggests that task-specific practice can reorganize spinal networks, but achieving sustained overground walking requires further investigation into increasing the excitability of these networks.

Practical Implications

Rehabilitation Strategies

Locomotor Training, which focuses on the neural plasticity of the spinal cord, is a rehabilitative strategy that can be successful for people with spinal cord injuries.

Sensory Input Optimization

Optimizing load-related and contralateral sensory input during retraining can improve motor output in patients attempting leg movement, standing, and stepping.

Future Research

Future studies should focus on approaches to increase the central state of excitability, such as neural repair strategies, pharmacological interventions, or epidural stimulation in combination with Locomotor Training.

Study Limitations

1
Inability to sustain complete independent stepping in individuals with clinically complete spinal cord injury.
2
Variability of initial locomotor patterns and complexity of the reorganization.
3
Difficulty in controlling factors such as anti-spasticity medication levels, time since injury, and injury characteristics.

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